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'Crossing Jordan's' viral outbreak: Do we smell a rat?

March 26, 2007|Marc Siegel | Special to The Times

"Crossing Jordan," NBC, March 14, 9 p.m. "Isolation."

The premise: An autopsy performed by Dr. Jordan Cavanaugh (played by Jill Hennessy) discovers hantavirus in a man's bodily fluids. The virus, which can be transmitted by rodent droppings, is rarely found in a big city such as Boston. Soon, other people begin to report difficulty breathing and symptoms such as headaches, body aches, rash and fever.

Cavanaugh's team of coroners believe the outbreak is due to hantavirus pulmonary syndrome, and that victims have breathed in aerosolized droppings of whatever animal has caused the outbreak. They begin testing human contacts of victims, who are found to be negative for the virus -- as are rodents that are trapped and tested.

The antiviral ribavirin and a hanta vaccine are brought in; the sick people get the ribavirin and all suspected contacts are vaccinated. Lily Lebowski (Kathryn Hahn), a pregnant grief counselor serving in the Boston medical examiner's office, refuses to take either the antiviral medication or the vaccine for fear of birth defects.

Ultimately, investigators determine that an infected coyote, or people smuggler, brought the virus from Mexico, spreading it although he was asymptomatic. Eventually, the outbreak is contained, and Lebowski tests negative for hantavirus exposure.

The medical questions: How common is hantavirus pulmonary syndrome and is it described accurately? Can it be transmitted from person to person via an asymptomatic carrier? Can it be controlled with the help of surveillance, antivirals and a vaccine? Under these circumstances, is a pregnant woman more at risk for the virus, or is her fetus more at risk from the preventives?

The reality: Hantavirus pulmonary syndrome has been found in humans in 30 states (460 cases as of January 2007), as well as South America and Canada, though it continues to be quite rare. Outbreaks in the U.S. have been traced to rodents -- spread via their urine, droppings and saliva, which can become aerosolized and inhaled by humans. Antibodies to the virus have also been found in cats, dogs, pigs, cattle and deer. No cases of human-to-human transmission have been reported in the U.S.; however, an outbreak in Argentina in 1976 did appear to be spread among humans. The show's depiction of an asymptomatic spreader is improbable but not impossible.

Early symptoms of the syndrome include fever, muscle aches, headache, fatigue and abdominal pain. Rashes are characteristic of the hemorrhagic renal but not the pulmonary syndrome. As the lungs fill with fluid, symptoms progress to coughing and shortness of breath.

According to the Centers for Disease Control and Prevention, there is no proven treatment or effective vaccine for a hantavirus pulmonary syndrome. Ribavirin, the only approved antiviral treatment that has been shown to be effective against hantaviruses in the test tube, has not yet been shown effective against the syndrome in patients. And a study in the January 2006 issue of Emerging Infectious Diseases, published by the CDC, reported that a genetically engineered hantavirus vaccine that has been tested in hamsters and monkeys is likely to be of limited use because of variations in the strains of hantavirus.

So though the use of state-of-the-art surveillance and containment procedures are shown accurately in the show, the use of ribavirin and vaccines are fictionalized for dramatic effect. And ribavirin can cause birth defects. Lebowski is right to refuse it.


Dr. Marc Siegel is an internist and an associate professor of medicine at New York University's School of Medicine. He is also the author of "False Alarm: The Truth About the Epidemic of Fear." He can be reached at

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